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Montana rates for HCPCS 21401

Closed treatment of fracture of orbit, except blowout; with manipulation

Insurance Carrier
Aetna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$331.13 / $524.81 / $1,288.25
Cigna
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.81 / $524.81 / $524.81
Cigna
Facility/Professional
Professional
Modifier
Low / Median / High Price
$309.03 / $501.19 / $812.83
MountainHealth Co-op
Facility/Professional
Facility
Modifier
Low / Median / High Price
$524.81 / $812.83 / $912.01
MountainHealth Co-op
Facility/Professional
Professional
Modifier
Low / Median / High Price
$524.81 / $812.83 / $912.01
Providence
Facility/Professional
Facility
Modifier
Low / Median / High Price
$338.84 / $524.81 / $870.96
Providence
Facility/Professional
Professional
Modifier
Low / Median / High Price
$79.43 / $537.03 / $1,023.29
United
Facility/Professional
Professional
Modifier
Low / Median / High Price
$436.52 / $616.60 / $912.01